The Last Pandemic

by E. Thomas Ewing

E. Thomas Ewing is a professor of history at Virginia Tech, where he teaches courses in the history of medicine, Russian history, and data in social context. He has directed projects on the history of disease, medicine, and health funded by the National Endowment for the Humanities through summer educational programs, Digging into Data, and the digital humanities.

In a September 22, 1918, editorial, the Evening Star in Washington, D.C., took measure of the influenza epidemic then sweeping the country. “The so-called Spanish influenza,” while “not exactly identified,” was “virtually the same disease as that which swept over the country nearly thirty years ago.” The earlier epidemic, which the newspaper referred to as the “Russian influenza,” produced the same symptoms: sneezing first, and then pains in the extremities, and an exhausting fever.

The editorial noted that influenza is “highly infectious,” as sneezing “carries the germ into the air, where it floats about for an appreciable time, possible to be breathed by others.” Patients with identified symptoms should not attempt “self-applied remedies,” but instead should immediately consult their physicians. The editorial also advised people to stay away from crowded spaces, get lots of fresh air, and walk to work to avoid packed street cars.

This advice on how to respond to an outbreak of infectious diseases will sound familiar to anyone experiencing the public health crisis of COVID-19, when nearly the entire world was advised to stay home, practice social isolation, and seek medical treatment if sick. Yet one well-intentioned recommendation from the 1918 editorial stands out for being completely mistaken: Influenza, the newspaper said, was “a distressing disease,” but fatal only “to a slight extent.” The greater danger, said the newspaper, was “agitation” itself, which might spread the disease.

This confident statement that influenza should not prompt “public alarm” would seem absurd in the coming months as the epidemic claimed upwards of 650,000 deaths in the United States. Historians have long recognized, and criticized, the failure of public health officials in 1918 to appreciate the severity of the epidemic and take appropriate measures in the early stages of the outbreak. Understanding how and why highly trained scientists, accomplished public officials, and responsible journalists made inaccurate predictions requires an appreciation of how they looked to history for guidance yet came away with the wrong lessons. The 1890 crisis could have taught public health officials in 1918 to anticipate a severe outbreak and to take appropriate precautionary measures, but somehow it didn’t. As we look to history for lessons in early 2020, we need to think broadly about how understanding the complexity of the past can inform decisions in the present and the future.

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